Individual
MR. DARRICK LAMONT CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
111 HOLLY MILL VILLAGE DR, CANTON, GA 30114-7175
(678) 787-8173
Mailing address
111 HOLLY MILL VILLAGE DR, CANTON, GA 30114-7175
(678) 787-8173
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3053
GA
Other
Enumeration date
02/09/2009
Last updated
02/07/2017
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